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Country of registration

Phone number

Startup or existing?

Business name

Registration number

Date of incorporation

Legal address line 1

Legal address line 2

City

Post index

Operation address same as legal

Operation address line 1

Operation address line 2

City of operations

Post index

First name

Last name

Date of birth

Position in company

First name

Last name

Ownership %

Business category

Funding amount required €

Term of repayment

Business description

What is it that you need funding for?

How do you see the future, and possible repayment capacity?

What are main risks you see in realizing your project?

Guarantees you are able to provide

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